The Effects of Giving on Givers In press 2011 Handbook of HealNicole R - PDF document

1 The Effects of Giving on Givers In press
The Effects of Giving on Givers In press (2011); Handbook of HealNicole Roberts & Matt Newman (Eds.) APA Books. Department of Psychiatry, University of Rochester Medical Center Stephanie Brown ACKNOWLEDGEMENTS time of writing this arwas supported by a grant from the Nationawas supported by a grant from Wake Forest University via the John Templeton Foundation (Dispositional Empathy as a Character Trait). Ever since the groundbreaking study by House, Landis, & Umberson (1988), in which the tionships were equally important ealth as smoking, has exploded. An updated meta-analysis on 148 prosSmith, & Layton, 2010). This effect is stable This is a complex issue, however, because social relationships encompass both giving mmarize research on the health outcomes associated with being time point) or longitudinal (i.e. study following individuals over time to examine the effect of giving or receiving help on some sort of health outcome), but a few experiments do exist. Cross-sectional studies are difficult to interpret because the direction of causality between ample, a cross-sectional study have improved health outcomes could mean thatcould also mean that people who feel more physically healthy are more likely to volunteer. With cross-sectional studies, there is also the possibility that another variable best explains the relationship. For example, it is possible that people with higher annual incomes are more likely er health. Thus, income could Longitudinal studies can clarif(e.g. volunteering) comes before another (e.g. health), but the problem ofexist in these types of studies. This does not mexperimental, but rather, that ousmoking, obesity) are derived from longitudinal terous to randomly assign people to smoke or not. So, we see much validity in the longitudinal method, but thirG SUPPORT FROM OTHERS As reviewed below, there is a lar

2 ge literature on receiving support from
ge literature on receiving support from others, and the majority of it suggests that there may be minor hhealth effects of receiving support from others are complicated by recipient need. It is likely that people with ongoing health problems will be more likely to receive help from others, and this is also complicated by viduals more likely to be seen as needing help, regardless of their actual need state. There are also likely issues with respect to recipients’ sense of efficacy and personal mastery that would be important to study within this literature. available network of supporters is associated with a number of positive mental and physical health outcomes, including better stress regulation and improved recovery from illness (Katz, Monnier, Libet, Shaw, & Beach, 2000; Lindorff, 2000; Monahan & Hooker, 1995). This may be , but may also be explained by something about more optimistic worldviews. When it comes to tionship appears to be more complex. For example, receiving social support has been associated with increased depression, feelings of guilt, and feelings of dependency in correlational studies (Liang, Krause, & Bennett, ontrolled for a number practical support from friends and family membNesse, Vinokur, & Smith, 2003). Receiving social support has also been linked with better mental and physical health in Keyl, Marcum, & Bode, 2009; Schwartz, Meisenhelder, Ma, & of the study (S.L. Brown, Brown, House, & Smith, 2008). A meta-analysis examining the overall effectand physical health outcomes found relatively small effect sizes, ranging from -.02 to .22 (C. Smith, Fernengel, Holcroft, Gerald, & Marien, an individual’s need for and acceptance of social support is necessary before employing the commonly recommended interventions of self-help, bereavement, and marital or family therapy groups” (Smith et al, 1994, p. 358). Ot

3 her meta-analyses have found that the sm
her meta-analyses have found that the small beneficial e mediated by positive cardiovaresponses (Thorsteinsson & James, 1999; UcThere are several factors that appear to determine whether receiving support will have a positive effect on the health of recipients. One factor is the gender of the recipient. Although Smith et al. (1994) found that gender did not moderate the outcomes, more recent research suggests that researchers must take into account gender norms that make it more difficult for men to accept and benefit from help. For example, one correlational study found that men who received was for an important problem (Lindorff, 2000). Women did not experience this adverse outcome. A recent experimental study randomly assigned participants to receive support or not from someone with whom they had just formed a bond or not. Participants were then told that was assessed before and after the speech. The researchers found that cortisol increased dramatically in men who received social support from a women (A. M. Smith, Loving, CrPersonality traits may also determine whether health benefits. For example, one study randomly assigned female participants to receive social support (i.e. positive feedback) or not during a social stress task (e.g. giving a speech). Participants only experienced dampened physiologia compassionate personality. Partmpassion and received social compassionate people are more willing to seek out and accept social support when needed effect of receiving support (e.g. trust, optimism), and future research should consider this blatancy of the support. Some pect manner, but fail to consider how it might feel to receive suchaffect recipients’ sense of autonomy, competence,may have accrued otherwise (Bolger & Amarel, try to minimize their support attempts or make them altogether invisible. For example, an effective suppor

4 ter might realize a statistics problem,
ter might realize a statistics problem, and rather might ask the professor to clarify the questiStrategies such as these have b(Bolger & Amarel, 2007). Finally, that another way to minimize potential negative outcomes of receiving help is to give support in return. Reciprocity of helping seems to be an important predictor of positive social support experiences (Buunk, Doosje, Jans, , Bolger, & Shrout, 2003). THE EFFECTS OF GIVING SUPPORT TO OTHERS “A generous person will prosper; whoever refreshes others will be refreshed.” giving on givers, which is the main focus of mplex, with people who are healthie be measured and covaried in studies that are interested in the health effects of giving on the giver. Is it better to give than to receive? As will be seen, there are resources (i.e. time, money, and care) to others, es leaning toward the meta-analyses to date that would assess this question more quantitatively. Behaviors themselves can range widely from informal support and care to formal giving experiences such as volunteering. What each of these has in common is that they are all focused on increasing others’ well-being, whether simply in desire (e.g. concern for others) or in reality (e.g. by providing tangible assistance). Attempts to understand the mechanisms for giving effects ng its flip side, or extreme self-focus. Thus, we also summarize work on the health-related outcomes associated with a higher self-focus. Giving time and money to organizationsbehavior and health is relatively well-establishebetween making charitable donations and psychoistent across many diffeet al., 2010). What remains to be seen is whether giving to others makes people happier, happier people simply give more, or some third The majority of studies on volunteering and tions as well, including younger adults (Musick & Wilson, 2003), doctors (less burwith

5 post-traumatic stress disorder (better t
post-traumatic stress disorder (better treatment outcomes; (Warren, 1993). In both correlational and longitudinal studies, volunteers report more positive affect, life satisfaction, and 2004; Lum & Lightfoot, 2005; Musick & Wilson, 2003; Piliavin & Siegl, 2007; Sarid, Melzer, Kurz, Shahar, & Ruch, 2010; Thoits & Hewitt, 2001; Van Willigen, 2000; Windsor, Anstey, & Rodgers, 2008). There seems tovolunteering such that there are mental health benefits associated with moderate levels of volunteering, but not extremely high levels (i.e. 800 or more hours per year; Windsor et al, Studies on physical health outcomes associated with volunteering almost entirely focus ed risk of health problems, functional limitations, and ultimately, mortality. Longitudinal studies find that volunteers report ving fewer functional limitations than non-volunteers, even when controlling for demographic and socioeconomic variables (Lum & Lightfoot, 2005; Piliavin & Siegl, 2007; Thoits & Hewitt, 2001; Van Willigen, 2000). A number of longitudinal studies find experience a significantly reduced mortality risk several years later, even when including a host of covariates (Harris & Thoresen, 2005; Konrath, Fuhrel-002; Musick, Herzog, & House, 1999; Oman, Thoresen, & Mcmahon, 1999). Our recent work finds that the reasons why people volunteer are important determinants of whether they will experience this mortality risk decrease four years their time for other-oriented reasons (e.g. compassion) expein their mortality risk, but volunteering for more self-oriented reasons (e.g. to learn something new, or to feel good about themselves) is not associated with any change in mortality risk. In are just as likely to die as e for mental and physical health, there are inconsistencies with regard to how much the type, number of organizations, ng matters, with some researchplay

6 no role and others finding that they ma
no role and others finding that they matter. A meta-analytic integration of the literature ven encompass both practical (e.g. money, time, errands) and more emotional typefriends and family. Several correlational studies associated with higher psychological well-being such as more happiness, increased self-esteem, e findings are confirmed in l, 1999). Experimental and quasi-experimental studies find that people who are randomly assigned to such behaviors as ving massages to infants, experience increased Quintino, Schanberg, & Kuhn, 1998; Langer & Rodirelated to more positive outcomes. One study found that there was no relationship and some studies have found that at times giving social supporburden and frustration (Fujiwara, 2009; Lu, 1997; Lu & Argyle, 1992), especially if others make too many demands, if givers become overwhelmed by others’ problems, or if there is low Broom, 2007). is more consistent in the literature. In correlationaated with positive health outcomes adults and longer-term survival among people hough this effect seems to genecultural groups (W. M. Brown, et al., 2005), one study found that among teenagers the lth only existed in fema2009). Longitudinal studies again confirm physical er, 2006), and ultimately, a significolder adults or chronically ill patients (S. L. Brown, et al., 2003; McClellan, Stanwyck, & Anson, (e.g. family, friends) rather than more distanrimental and quasi-experimenexamine the physiological effects of giving in the laboratory point to potential mechanisms within the neuroendocrine system. (Field, et al., 1998; A. M. Smith, et al., 2009) aath, Seng, & Smith, 2011). Compassionate attitudes and traits A number of studies have examined the other-oriented measures such as compassion, altruism, caring, and empathy seek out more caregivi1983; K. D. Smith, 1992; Steffen & Masters, 2005). With

7 dispositional empathy declining over the
dispositional empathy declining over the past 30 years in the United States (Konrath, O'Brien, & Hsing, 2011), the issue of how empathy is related to health will likely become more important in the future. A number of correlational studies find that people who score high in empathy or compassion have lower stress, anxiety, hopelessness, and depression (Au, Wong, Lai, & Chan, predictors of mental health such as coping aschool students, college students, community samples, and people with chronic illnesses, yet the results are consistent. Even in jobs that are associated with high stress and potential compassion are more compassionate, caring, or prosocially-oconfirms that those who have altruistic personalities as adolescents have better mental health outcomes in late adulthood, even nd social class (Wink & Dillon, 2002). One potential mechanism of this effect is that compassionate people are more likely to seek, accept, and be satisfied with social support from others (Cosley, et al., 2010; Steffen & Masters, 2005). It is important to notecompassionate focus (i.e. empathic concern) versus a self-oriented em with poor mental health outcomes in contrast In terms of physical health, empathy participate in fewer hdrinking and smoking (Adams, 2010; Kalliopuska, 1992). One interesting experiment found that simply showing participants a film clip of an extremely compassionate exemplar (Mother Teresa) increased a biomarker of healthy immune functioning (S-IgA) compared to a control film clip. This effect was especially strong for participants who were high in affiliation moudies confirm that carted physical health, more robust immune responses in chronic illnesses, and are even lower in mortality risk several years later (Dillon & Wink, 2007; Ironson, e later health outcomes (Dillon & Wink, 2007) and another finding that the health outcomes was

8 robust to a number of plausible confoun
robust to a number of plausible confounds (Konrath & Fuhrel-Forbis, 2011b). eating) that are given to someone experiencing an illness or functional limitation. For example, the spouse ofsevere stroke or who is suffering from dementia at least some daily caregiving activities. Similarly, parents of children with disabilities other circumstances, and 3) it often involves considerably more cost to the self in terms of time, compared to other types of giconsiderably more stressful experience for gique features of caregiving contexts (e.g. the tory bereavement) from the effects of actually A meta-analysis of 23 studies that compared dementia caregivers to age and gender-matched non-caregivers found that caregivers self-reported more health problems, more physical symptoms, and more medication usage, and also had more stress hormones and weaker immune responses, compared to non-caregivers (Vital effect of caregiving on health was statistically significant, there outcomes in the studies, suggesting that caregiving does not necessarily lead to poor health outcomes in itself, but likely interacts with a number of factors to predict such outcomes. For example, meta-analyses find that caregiving is associated with more negative physical health outcomes for women (Pinquart & nd people from ethnic minority e that women, older adults, and people from ethnic minorities also tend to be groups with lower socioeconomic resources relative to men, middle-aged adults, and Caucasians. Specific feathealth outcomes. Caregivers who more caregiving tasks, for a more impaired (physically and cognitively) impaired recipient, for longer periods of time are and physical health problems, es exhibit behavioral problems (Pinquart & Söreaccess to greater economic resources and social support (Pinquart & Sörensen, 2007). Taken ssociated with caregivi Recent research

9 highlights the importance of tce of actu
highlights the importance of tce of actual support giving behaviors from the influence of such risk3376 older adult caregivers (age 70+) from the Health and Retirement study, researchers found that hours of care given and spousal impairment independently predicted mortality status 7 ng 14 or more hours of care per week to spouses lower mortality risk, and at the same time, caregivers whose spouses had more functional impairments had a mortality risk. These effects remained even when controlling for potential demographic (age, gender, race), socioeconomic (education, employment status, net worth), and depression). Another recent study using the method of ecological momentary assessment demonstrated the importance of separating time spent actively helping spouses from time being needed (Poulin et al., 2010). The researchers found that the more caregivers actually helped their spouses, the moremore time they were “on call,” the less positive affect they experienced. This effect was e who reported being in more interdependent relationships experienced more d more negative affect Another study found that empathy can be a double-edged sword when it comes to hand, caregivers who were high in a more form of empathy, reported lower stress and This is likely because cognitive empathy allows one to consider the perspectives and needs of others, but also allows for some emotional di empathy reported lower life satiking and emotional empathy are typically positively correlated (Davis, 1983), they are not identical, and their differences may be important when considering extremely high-stress, time-intensive, and unavoidable situations like informal caregiving. The majority of this chapter has focused on the health benefits associated with being focused on others. But the c also deserves some attention. Are there negative health outcomes assoin s

10 elf-focus? This is something that has be
elf-focus? This is something that has been less frequently studied in the literature, but it will likely become increasingly important with societal rises in individualism, self-esteem, and narcissism over the past few decades (Twenge, 1997; Twenge & Campbell, 2001, 2008; Twenge, Campbell, & Gentile, 2011; Twenge, Konrath, Foster, Campbell, & Bushman, 2008). Self-esteem and the personality trait narcissism are associated with positive mental health outcomes. For example, people with high self-esteem have high satisfaction with their lives and 1987). It’s not surprising that self-esteem is associated with positive mental health outcomes, and indeed, it is sometimes seen as a marker of mental health in itself. narcissism are positively correlated, people with high self-esteem have positive views of the self higher in narcissism see themselves as superior and others as rcissism also have lower depression, anxiety, mashiro, & Rusbult, 2004; Watson & Biderman, subjective well-being as comparin narcissism (Watson & Biderman, 1993). This is despite their documented difficulties in maintaining healthy interpersonal relationships (W. K. Campbell, Foster, & Finkel, 2002). Whether these apparent mental health benefits associated with narcissism run deep, are a result of some sort of defensive self-enhancement, orssism’s correlation with self-esteem (Rosenthal & Hooley, 2010) remains to be seen. Narcissism makes individuals susceptible toself-views that are difficult and stressful to continuously maintain (Morf & Rhodewalt, 2001). Attempting to maintain them may lead to chronic hyperactivatstress response system, which in the long term could weaken the body’examining the physical health outcomes associated with narcissism is as important as examining mental health outcomes associated with it. Aof stress responses among narcissists. Males who sc

11 ore high in narcissism have high levels
ore high in narcissism have high levels of stress hormones compared to males who score low delstein, Yim, & Quas, 2010; Reinhard, Konrath, Cameron, & Lopez, 2011). There is no relationship between narcissism and cortisol among women. Among men and women, narcissism is related to increased cardiovascular reactivity when thinking of stressful stimuli (Kelsey, OrnduArthur, 2002). Similarly, thinking ofte for men and women scoring high on narcissism (Sommer, Kirkland, Newman, Es Our recent work found that it is not necessary to score hinarcissism to experience some negative health outcomes. Simply focusing on personal benefits that one may receive from volunteering is sufficient. In unadjusted models, more self-oriented ciated with increased mortality effect was reduced to non-significance when cova, but simply focused on mundane potential benefits that volunteers might experiocus need not be too extreme to be costly to Another way to conceptualize self-focus is to measure people’s first person pronoun use (e.g. I, me, my, mine). This method is useful because unlike something as chronic as a trait or set of core motives, there are likely changes insituations. Several studies have ndividuals use more first person , especially the word “I” (B Weintraub, 1981). Although the direction of causality is unclear, these studies suggest that excepoor mental health. Indeed other research confirms that poets who later committed suicide made more first person singular pronouns, compared to non-suicidal poets (Stirman & Pennebaker, Excessive first person pronoun use is also assohealth outcomes. One program of research examined such usage in the t disease (Scherwitz & Canick, 1988; Scherwitz, Graham, & Ornish, 1985) blood pressure, more occluded arteries, a more ious myocardial infractions, and a greater risk of mortality in longitudinal studies. These e

12 ffects remained even when other importan
ffects remained even when other important risk factors were covaried (e.g. age, smoking, cholesterol). Taken together, it appears that self-focus might at times be linked to poor mental health, seems to be linked to increased physiological indicators of stress, and ultimately, to coronary heart disease. However, the work on this topic has many more gaps than on the topic of altruism and health, and much future research is THEORETICAL MODEL OF CAREGIVING AND HEALTH We next present a theoretical model of caregiv by predicting under which circumstthe topics discussed above. caregiving system which is a physiological (hormonal, (cognitions, emotions) system thcreation and maintenance of soci2011). This caregiving system has been demonstrated to drive maternal (Numan, 2006), and may facilitate human helpinthe desire to help (i.e. approach motivation) by decreasing the desire to(Numan, 2006). This system is hypothesized to h over time, should lead required (e.g. service learning, or community serv that it can somehow benefit themselves (e.g. advance their career). This model allows for these other reasons, and simply argues that these lp will not activate the caregiving system, and thus should not lead to bis, et al., 2011, for an example). Figure 1. A Model of Caregiving This model posits that one of the downstream consequences egiving motivations is increased stress regulation. Studies of both human and animal maternal behavior provide initial evidence for exactly this process, finding that the neuroendocrine system releases hormones suchsterone during normal maternal-infant interactions (Feldman, Gordon, Schneiderman, Weisman, & Zagoory-Sharon, 2010; Numan, 2006). Interestingly, givisource of stress (e.g. from of having fewer resources (time, money, energy). This model posits that caregiving motivations can help to alleviate gi

13 vers’ stress om the giving behavior itse
vers’ stress om the giving behavior itself. There are a number of factors that make it more likely that caregiving motivation will be elicited. First, relational bonds between helpers and recipients are posited to be important, an idea which is consistent with a recent evolutionary theory of social bonds and altruism (S. Brown & Brown, 2006). Indeed, there is experimental evidence that relationship variables themselvesegiving-system hormones such al., 2010), but the caregiving literature, which predominantly focuses on spouse caregiving, suggests that other factors may also be at play. type and quality in order to predict examine when giving predicts better health outcomes. There are a number of indihypothesized to affect whether giving will be beneficial or costly to givers’ health. We a role in such outcomes, and in particular, that women whose caregiving systems have been primed wlikely to benefit from giving. Some research described above found that women were more likely to benefit from giving (Schwartz, et al., 2009), moderating role in future research. Traits that help people to more easily form bonds with others activation of the caregiving system insecure) and dispositional empathy should also stress-regulation. As reviewed above, in most cases, having an empathic or compassionate personality is associated with a number of health benefits, and it is possible that this is because of a chronic activation of the caregiving system. The availability of time, attention, money, and energy should predict better health outcomes associated with giving, because these resources can keep the motivational focus on the recipient of care rather than the giver’s own worries. This is consistent with the Energy-Resource Model of Empathic Respfor another is costly in terms of energy units, and some people find these acts costlier than othe

14 rs. Resources likely interact with relat
rs. Resources likely interact with relationship variables and individual differences to predict optimal health outcomes from giving to others. For example, a high empathy person will likely find a small act empathy person would, because the more frequent flexing of empathic capacities in higher empathy people likely renders them more auThis example highlights the contextual natuliteral in defining them. The subjective report of participants (e.g. “I barely have time to think”) likely matters just as much as any objective indicators (e.g. only having a part-time job). That bee caregiving literature is that caregivers who objectively have more resources are less likely to suffer from negative health Possible alternative routes It is possible that positive emotions also explain why the altruism and health relationship exists. Helping e emotions in helpers (Yinon & Landau, 1987), and positive emotions themselves can accelerate recovery from tive emotions also predict Snowdon, & Friesen, 2001). Similarly, giving to others may also buffer stress and improve health outcomes because it increases a sense of purpose or meaning in volunteers’ lives it is activated (i.e., through the gers positive emotions or an ress regulation, with implications for long-term health. Future research should also examine thesFUTURE RESEARCH DIRECTIONS This review of the literature on the healthvers has revealed a number of gaps in the literatuticular, mechanisms of the giving-these could be elucidated by experimental studies that examine the immediate and longer-term causal effects (both positive and negative) of are examining the immea series of experiments we are examining whether characteristics of the helper empathy) affect whether there will be positive phity). We are also experimentally manipulating the degree of responses. Laboratory studies can allow resear

15 chers to systematically vary a number of
chers to systematically vary a number of other they influence immediate physiological outcomes. In addition, longer term experiments (interventions) could examine how these processes work over time once In addition, nearly all of thWestern cultures and on predominantly White samples, and there is a need to examine whether positive effects of giving on givers extend to people of different ethnic and cultural backgrounds. This would be an important testfundamental to humans. Although there may be cultural variations in moderators of the altruism-giving motivation is activated (See Figure 1), should be more universal. Another potentially interesting area for further research is literature. Many studies examine processes among are aware of examining whether there are immediatits of helping among clarify the limits of for example, that caregiving motivation buffers people from stress only when this motivation becomes biologically critical for the survival of the species (i.e. at the age of childbearing ce physiological benefits from the caregiving system outside of maternal behaviorand giving behaviors by a numbe Finally, we have noted a number of important meta-analyses that have focused on three ewed above. Notably missing are meta-analyses focusing on giving these are both more emerging would be informative. CONCLUSIONIs it better to give than to receive? Base health costs, and a number ofconsequences will lean one way or the other. We recommend that future researchers move good or bad for health, and instead examine these basic five questions: benefits from giving to others? associated with better health outcomes? is giving beneficial to hecircumstances? Wherewith health benefits? Answering these questions will theoretically integrate a number of related literatures, but will also have the important practical benefit of determin

16 ing the most REFERENCES Adams, A. (2010)
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